环形肌切开和全层肌切开治疗贲门失弛缓症的长期随访研究

Long-term efficacy of peroral endoscopic circular myotomy and full-thickness myotomy on treatment of achalasia of cardia

目的对比内镜下环形肌切开与全层肌切开治疗贲门失弛缓症的长期临床疗效及远期并发症。方法回顾性分析2012年6月至2014年12月于郑州大学第一附属医院消化内科行经口内镜下肌切开术治疗，并定期随访的53例贲门失弛缓症患者资料，其中21例行环形肌切开，32例行全层肌切开，比较2种术式的长期临床疗效及远期并发症。结果环形肌切开组和全层肌切开组治疗有效率分别为90.5%（19/21）和100.0%（32/32），差异无统计学意义（P=0.152）。2组术后Eckardt评分、食管下括约肌压力和4 s完整松弛压比较差异均无统计学意义（P〉0.05）。全层肌切开组临床相关胃食管反流发生率高于环形肌切开组（40.6%比14.3%，χ^2=4.174，P=0.041）。结论经口内镜下环形肌切开术与全层肌切开术治疗贲门失弛缓症长期疗效相当，但全层肌切开术后临床相关胃食管反流发生率更高。

ObjectiveTo compare the long-term efficacy and complications of peroral endoscopic circular myotomy and full-thickness myotomy for patients with achalasia of cardia.MethodsA retrospective analysis was performed on the data of 53 patients with achalasia of cardia, who underwent peroral endoscopic myotomy in the First Affiliated Hospital of Zhengzhou University from June 2012 to December 2014 and were followed-up regularly.Twenty-one patients underwent circular myotomy, and the other 32 patients underwent full-thickness myotomy. The postoperative long-term efficacy and gastroesophageal reflux complications of the two groups were compared.ResultsThe effective rate of the circular myotomy group and the full-thickness myotomy group was 90.5% （19/21） and 100.0% （32/32）, respectively（P=0.152）. There were no significant differences between the two groups on postoperative Eckardt scores, lower esophageal sphincter pressure and 4 s integrated relaxation pressure（P〉0.05）. The incidence of clinically relevant gastroesophageal reflux of full-thickness myotomy group was higher than that of circular myotomy group （40.6% VS 14.3%, χ^2=4.174, P=0.041）.ConclusionThe long-term efficacy of circular myotomy is similar to that of full-thickness myotomy, but the incidence of clinically relevant gastroesophageal reflux is higher in full-thickness myotomy.